كلية الطب والعلوم الصحية
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Item Hypoiaemia in children with sickle cell anaemia in Khartoum state(ALNEELAIN UNIVERSITY, 2004-07) Yassin Hag Mohammed HamidABSTRACT Sickle cell disease is often complicated acutely or chronically by hypoxaemia. This is a descriptive cross-sectional hospital based study aimed to determine the frequency and possible associated factors of hypoxemia in patients with sickle cell anaemia in their steady state and crises. it was conducted in the sickle cell anaemia referral clinic in KCEH and paediatric wards in most of Khartoum state hospitals in the period from the 15' of April to the 30"‘ of June 2004. The total number of children enrolled in the study was 149 children with sickle cell anaemia aged 0 - £16 yrs, 100 of them in their steady state while 49 were in crises and 80(53.7%) were males while 69(46.3%) were females . Oxygen saturation (SpO2) was measured for all children by pulse oximeter and haematological investigations were also done. The overall frequency of hypoxaemia (SpO2 s 90%) was found to be 37.6% and the mean SpO2 was 92.3% 1 6.0. The frequency of hypoxaemia in patients with steady state was 39% while in those with crises was 34.6% and there was no significant difference between the two groups (p = 0.373). There was no significant correlation between hypoxaemia and gender of patient but hypoxaemia was found to be more frequent in older age groups (p = 0.001) and in those with low weight centile (p= 0.028) but not with height (p = 0.864). Hypoxaemia was found to be associated with history of recurrent chest infection (p = 0.009) but not with history of blood transfusion or recurrent painful episodes. In patients with crises hypoxaemia was found to be correlated with breathlessness as a presenting symptoms (p =0.002) and there was a significant correlation with the type of crises (p = 0.031). Hypoxaemia was found to be correlated with low Hb (p = 0.000), low PCV (p = 0.005) and HbF (p = 0.001) but there was no correlation with retics count (p = 0.310)Item Heart Rate Variability and Asthma Control Test(ALNEELAIN UNIVERSITY, 2008) Mohamed Faisal Mohamed LutfiABSTRACT Background HRV is widely accepted to have prognostic significance in patients with cardiovascular diseases especially after acute myocardial infarction. However, recently. interest has grown in relating some pathologies with abnormal autonomic activity based on HRV studies. Although asthmatics are known to have enhanced cholinergic activity, little I-[RV studies were done on asthma patients. Moreover, the results of these studies are not reproducible, probably due to inter-individual differences of autonomic balance in test group or inadequately designed methods. Objectives l. To develop an effective spirometric score that can faithfully reflect ventilatory functions of the lungs and efficiently discriminating asthmatics from non- asthmatics 2. To detect reliability and validity of Asthma Control Test (ACT) and National Asthma Education and Prevention Program (NAEPP) in the classification of studied asthmatic patients based on above-mentioned spirometric score. 3. To correlate asthma control (using ACT and NAEPP) and ventilatory function with parameters of autonomic balance. 4. To detect the pattem of autonomic balance in asthmatics using a parameter known to be influenced by sympathetic and parasympathetic e.g. airways narrowing indicated by spirometry, blood pressure and blood glucose concentration. Methods The study involved 56 apparently healthy subjects and gender and an age matched group of 100 asthma patients classified into subgroups according to asthma severity using ACT and NAEPP classifications. Blood pressure, anthropometric. spirometric, HRV measurements together with drug therapy, blood level of glucose, hemoglobin and electrolytes were assessed for every subject. All spirometric measurements were condensed into one representative score (discrimination analysis score (DAS)) using discrimination analysis. Sensitivity and specifity of DAS were tested using conditional ratios and Receiver Operating Characteristic (ROC) curve. Screening of studied variables for significant correlations and mean differences among different groups with adjustment for possible confounding factors was perfonned using appropriate statistical techniques. Results Spirometry: Correlations between all spirometric measurements and DAS were highly significant (P = 0.000 for all correlations). DAS when compared with F EVl% (at the most accurate cutoff equal to 80%) as a predictive measurement for presence of asthma, is proved to be more sensitive (8l.00% for DAS and 71.00% for FEVl%). specific (94.14% for DAS and 92.86% for FEV1%) and accurate (86.54% for DAS and 78.85% for FEV1%). For further verification, accuracy of DAS was compared with the remaining of spirometric measurements using ROC curves. DAS is proved to be the most sensitive measure in diagnosing asthma (area under the curve = 0.933, P = 2.77E-l9 and 95% confidence interval 0.897 - 0.971). Of asymptomatic asthma patients, 34.0 % were labeled poorly controlled and 41.5% were labeled uncontrolled. ACT score was higher while NAEPP class was lower in symptoms free compared with symptomatic asthmatic patients (P = 0.000 and 0.005 respectively). DAS correlate significantly, but moderately, with ACT score and NAEPP class (P = 0.000 for both, CC = 0.38 and -0.49 respectively). Heart Rate Variability: Sympathetic tone (LF Nonn) of mild asthmatics was significantly lower while parasympathetic tone (HF Nonn) was significantly higher compared with apparently healthy subjects (P = 0.016 and 0.017 respectively). This was also true when mild asthmatics are compared with severe asthma patients (P = 0.020 and 0.015 respectively). ACT state of asthmatics correlate significantly, but weakly, with LF Norm (CC = 0.292, P = 0.003) and HF NOHTL (CC = 0.309, P = 0.002). Blood Pressure and Blood Glucose Concentration: ln contrast to systolic and mean arterial blood pressures, diastolic blood pressure was significantly higher in asthmatics compared with non-asthmatics (P = 0.002). Blood pressures correlate positively with sympathetic and negatively with parasympathetic activity in non- asthmatics (P < 0.05 for all). However, these correlations are lost in asthmatics. Blood glucose concentrations in asthmatic patients were significantly higher as compared with healthy subjects (P = 0.000). Blood glucose concentrations correlate positively with parasympathetic and negatively with sympathetic in non-asthmatics (P < 0.05 for all). Nevertheless, these correlations are lost in asthmatic patients. Conclusions DAS is more sensitive, specific and accurate compared with other spirometric measurements, but like other indicators it fails to reach 100% sensitivity and specifity on asthma diagnosis. Presence or absence of symptoms did not correlate with asthma control which draws attention to asthma classification criteria. The autonomic balance of mild asthma (showing high parasympathetic and low sympathetic activities) is different compared to the severe form of the disease (which showed normal parasympathetic and sympathetic activities). Autonomic balance might influence symptomatology but not ventilatory function Many signs of functional impairment (control of blood pressure and blood glucose concentrations) of the autonomic nervous system are noted in asthmatic patients. XIVItem Etiology of Community Acquired Pneumonia in Sudanese patients in KTH and ATH(ALNEELAIN UNIVERSITY, 2003-02) Afrah Yousif Adam HaroonAbstract This is a prospective study which was conducted in Khartoum teaching hospital, Alshaab teaching hospital and Alakademia charity hospital to determine the etiology of community acquired pneumonia in adult patients who required hospitalization and the antibiotics sensitivity ofthe isolated pathogen. lO4 patients were diagnosed as having community acquired pneumonia CAP during the period between July 2000- December 2002. The microbiological diagnosis was based on the results of sputum culture. In 47 patients (45.2%) the causative pathogen was isolated. Streptococcus pneumonae was isolated in 25 patients (24.8%), and it proved so tar as the most common organism responsible for CAP among patients in the study group which is similar when compared with that in western countries. Six patients (5.8%) proved to have tuberculosis as cause otiCAP. Most ofthe isolated Strept pneumonae was found to be sensitive to penicillin. Resistance to penicillin was detected in one patient who is originally from Chad. Most ofthe isolates were sensitive to cephalosporin and Quinolones.Item Prevalence of Intestinal Parasitic Infections among Displaced Children in Kassala Town(Al Neelain University, 2005-01) Mamoun Magzoub Mohamed OsmanFour hundred and fifty faecal specimens were collected from 450 displaced children around Kassala town aged from 6 moths to 13 years old and examined under microscope for the detection and identification of intestinal parasites. Microscopical examinations by two techniques were done (wet preparation and concentration technique by simple centrifugation). The examination explained that 80 (17.8%) were found to harbour stages of infective parasites. Four species of infective parasites were identified from individuals in all areas (displaced areas). These comprised the following Giardia lamblia (12.3%), H. nana (4.9%), E. histolytica (0.4%) and T. trichiura (0.2%) ' Out of 450 stool samples collected from children in urban area (Waw—nour) inside Kassala town 45 were found to harbour cysts trophozoites or eggs of pathogenic parasites. This constituted on overall prevalence (10%), two species of pathogenic parasites were identified from individuals in Waw—nour (urban area). These comprised the following: G. lamblia (08%) and H. nana (02%). The factors responsible for the spread of diseases include the low standard hygiene and environmental conditions and the lack of proper disease control measures. Also a comparison between two mentioned techniques was done on all specimens: displaced children specimens and urban children specimens.Item Seroepidemiologic Study of Brucellosis in Febrile Patients in Khartoum State(Al Neelain University, 2008) Adam Ahmed Adam MustafaBiucellosis is a zoonotic disease caused by bacteria of the genus Brucella. Humans are infected mostly due to animal contact especially through consumption of unpasteurized milk or its raw products from infected animals. Consumption and handling of other raw products of animals also constitute an important mode of transmission. Human brucellosis is a debilitating disease which is commonly misdiagnosed for other infectious and non-infectious febrile diseases. The objective of this study was to provide baseline data on human brucellosis among febrile patients in Khartoum State. The diagnosis of brucellosis case in this study depended on a clinical manifestation which was fever for at least two weeks coupled with serum antibody titre of 1:160 or more to Brucella melitensis or Brucella abortus by using Standard Tube agglutinatonTest technique. The prevalence of human brucellosis was 8.9% among febrile patients in Khartoum State. Sixty three (70.8%) of the brucellosis patients were males, and 26 (29.2%) were females. Males constituted a significantly high number of patients than females. The males to females ratio was 2.4:l. ~ Fifty four (60.7%) of the brucellosis patients had significant titres to Brucella melitensis with a mean serum titre of 1:373. Twenty three (25.8%) patients had significant titres to Brucella abortus with a mean serum titre of 1:327. Twelve (13.5 %) of the patients had significant titres to both Brucella melitensis and Bruqella abortus with mean serum titres of 1:332 and 1:321 respectively. Risk factors for Human brucellosis include animal contact, particularly among people of certain occupations such as herdsmen, milkmen and those involved in meat industry. In addition, males were more exposed to infection than females, while both males and females at their mid-forties were more susceptible to infection than other age groups. High index of clinical suspicion of human brucellosis is needed for early diagnosis and management of the disease. More studies on the biology and epidemiology of Brucella species are important so as to reach a rational strategy for diagnosis, treatment and prevention of the infection.Item Seroepidemiologic Study of Brucellosis in Febrile Patients in Khartoum State(Neelain University, 2008) Adam Ahmed Adam MustafaAbstract Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella. Humans are infected mostly due to animal contact especially through consumption of unpasteurized milk or its raw products from infected animals. Consumption and handling of other raw products’ of animals also constitute an important mode of transmission. Human brucellosis is a debilitating disease which is commonly misdiagnosed for other infectious and non-infectious febrile diseases. The objective of this study was to provide baseline data on human brucellosis among febrile patients in Khartoum State. The diagnosis of brucellosis case in this study depended on a clinical manifestation which was fever for at least two weeks coupled with serum antibody titre of 1:160 or more to Brucella melitensis or Brucella abortus by using Standard Tube agglutinatonTest technique. The prevalence of human brucellosis was 8.9% among febrile patients in Khartoum State. Sixty three (70.8%) of the brucellosis patients were males, and 26 (29.2%) were females. Males constituted a significantly high number of patients than females. The males to females ratio was 2.4: 1. Fifty four (60.7%) of the brucellosis patients had significant titres to Brucella melitensis with a mean serum titre of 1:373. Twenty three (25.8%) patients had significant titres to Brucella abortus with a mean serum titre of 1:327. Twelve (13.5 %) of the patients had significant titres to both Brucella melitensis and Brucella abortus with mean serum titres of 1:332 and 1:321 respectively. Risk factors for Human brucellosis include animal contact, particularly among people of certain occupations such as herdsmcn, milkmen and those involved in meat industry. In addition, males were more exposed to infection than females, while both males and females at their mid-forties were more susceptible to infection than other age groups. High index of clinical suspicion of human brucellosis is needed for early diagnosis and management of the disease. More studies on the biology and epidemiology of Brucella species are important so as to reach a rational strategy for diagnosis, treatment and prevention of the infection.Item Mechanisms on childhood overweight and obesity at high altitude(AL-Neelain University, 2005) Humeda Suekit HumedaAbstract Objectives: The present study with its three parts, was undertaken to: (a) Describe the body composition and determine the prevalence of overweight and obesity in high altitude children‟s population and compare them their counterparts at low altitude, (b) Determine the possible mechanisms by which high altitude influences childhood body composition and the prevalence of overweight and obesity, (c) Explore the possible role of administration of antioxidants during pregnancy at high altitude in preventing late childhood overweight and obesity. Materials and methods: The first part was a cross-sectional prospective study of 145 Saudi children born and living permanently at high altitude (3100m) and 154 Saudi children born and living permanently at relatively low altitude (500m). For each child selected information regarding birth weight and breast feeding were taken from his or her file. Anthropometric measurements were then performed. Body mass index was calculated using the equation BMI=(Weight (kg)/Height (m2). Fat mass and fat free mass percentages were derived from triceps skinfold measurement. Resting pulse rate (beats/min), blood pressure, haemoglobin concentration and haematocrit value were measured. Physical activity level was determined using the short form of international physical activity questionnaire (IPAQ-SF). The second part was also a cross-sectional prospective study which included 25 healthy pregnant women and their healthy newborns from high altitude and equal numbers from low altitude. Measurements of maternal haemoglobin concentration, haematocrit value and blood pressure were made at the end of gestation. Foetal haemoglobin concentration and haematocrit value were determined immediately after delivery. Determination of the newborn's body shape andItem Neuroprotective Potential of L-NAME as Anti-Oxidant and Anti-Inflammatory in Cerebral Injury Induced By Transient Focal Ischemia Reperfusion in Rats(AL-Neelain University, 2005) Hiba Ahmed Alsheekh AwoodaAbstract: Background: Stroke is a major cause of death and disability globally. The function of nitric oxide (NO) in cerebral ischemia/reperfusion (I/R) has been intensively investigated; however, the exact role of NO inhibition in cerebral ischemia remains controversial. Aim: This study explored the possible neuroprotective effect of nonselective Nitric Oxide Synthase (NOS) inhibitor N-Nitro-L-Arginine-Methylester (L-NAME) in rat’s transient cerebral I/R. Materials and Methods: 30 adult male Wistar rats (150-250g) were divided into three groups 10 rats in each: First group was sham-operated and served as a control. I/R group of rats infused with 0.9% normal saline intraperitoneally 15 minutes prior to 30 minutes of left common carotid artery occlusion, followed by reperfusion for 24-hour, and a test group infused with L-NAME (15 mg/kg per weight) intraperitoneally 15 minutes prior to similar I/R periods. Neurobehavioral assessments were evaluated, Western blotting was used to estimated Nuclear factor kappa B (NF-қB) and quantitative -Enzymewas measured by α) -α (TNF-Tumor necrosis factormeasurement of nitrite and nitrate), and NO metabolites ( )ELISA(linked immuno sorbent assay malondialdehyde (MDA), and total antioxidant capacity (TAC) were measured colorimetrically in both plasma and affected cerebral hemisphere. Results: The L-NAME group showed a significant improvement in neurological deficit (M±SD = 15.07±0.584) compared to both I/R and control groups (12.798±0.689, 17.50±0.707, respectively P <0.001). In I/R rats NF-қB was significantly increased (129.2±1.7 RGB unit/mg protein) compared to the control group (53±1.03RGB unit/mg protein) and L-NAME pretreatment resulted in a significant decrease in NF-қB (44.4±1.3RGB unit/mg protein, P <0.001) compared to I/R group. The serum level of TNF-α was significantly increased in I/R group (734.8±108.9 pg/ml) compared to the control group (37.18±10.183 pg/ml), while L-NAME administration resulted in a significant decrease in serum TNF- α (64.36±11.053, P <0.001) compared to the I/R group. The brain tissue of TNF-α in the I/R group (110.4±6.2pg/mg protein) was significantly increased compared to the control group (4.9±0.8 pg/mg protein), L-NAME administration resulted in a significant decrease in tissue level of TNF-α (21.60±2.289, P <0.001) in compared to the control and I/R groups. Serum level of MDA and NO were significantly increased in I/R group (14.88±1.14 nmol/mL, 42.03±4.558 μmol/L respectively) compared to the control group (5.43±0.44 nmol/mL, 17.84±0.701 μmol/L respectively, P <0.001), while L-NAME administration resulted in a significant decrease in serum MDA and NO (7.18±0.135 nmol/mL, 18.44±0.513μmol/L respectively) compared to the I/R group. The serum level of TAC in the I/R group (1.21±0.169 mM/L) was significantly lower compared to the control group (2.52±0.062 mM/L), L-NAME pretreatment resulted in significant higher serum level of TAC (2.53±0.067 mM/L, P <0.001) compared to rats treated with normal saline. Regarding brain tissue levels of MDA and NO, the I/R group demonstrated a significant increase in the tissue level of both MDA and NO (8.56±0.658, 8.88±0.572 nmol/mg protein) compared to the control group (3.24±0.226, 3.48±0.228 nmol/mg protein, P <0.001). The L-NAME group showed a significant decrease in tissue level of MDA and NO (3.18±0.155, 4.47±0.392 nmol/mg protein, P <0.001) compared to the I/R group. The brain TAC level of the I/R group (0.0186±0.00373 mmol/mg protein) was significantly decreased compared to the control group (0.070±0.0085 mmol/mg protein, P < 0.001) On the contrary, administration of L-NAME prior to ischemia resulted in significant increase of brain TAC level (0.0747±0.00563 mmol/mg protein, P < 0.001) compared to rats subjected to saline infusion. NAME -These data demonstrated that L :nclusionsCoand Discussion significantly improve neurological deficit and L-NAME showed a potential ’sinflammatory effect in a rat-oxidant and anti-antiis through it tionneuroprotecmodel of transient focal cerebral ischemia reperfusion. الخلفيه: السكتة الدماغية هي سبب رئيسي للوفاة والعجز البدني عالميا. وقد تم التحقيق بشكل مكثف في دور أكسيد النيتريك (NO) في الفاقه الدمويه و اعاده ضخ الدم للدماغ, وبالرغم من ذلك فان الدور الفعلي لتثبيط NO في نقص الترويه الدماغي لايزال مثيرا للجدل. الأهداف: استنادا إلى هذه الملاحظات فان الغرض الرئيسي من الدراسه الحاليه هو استكشاف التاثير الوقائي المحتمل للاعصاب الناتج عن المثبط للانزيم المصنع لاكسيد النيتريك N-Nitro-L-Arginine-Methylester (L-NAME) خلال الفاقه الدمويه المؤقته للمخ و اعاده ضخ الدم في الفئران. المواد والطرق: اجريت هذه الدراسه علي 30 فئرا ذكرا بالغا من فصيله ويستار(تتراوح اوزانهم بين 150– 250جم) وتم تقسيمهم الي ثلاثه مجموعات تجريبيه 10 فئران في كل مجموعه. المجموعة الاولى (المجموعة المراقبة): وقد اجريت لهم عمليه خادعه. المجموعة الثانيه: قد خضعوا الى 30 دقيقه من نقص التروية الدماغية بواسطه انسداد الشريان السباتي الأيسر المشترك وتلاها اعاده لضخ الدم لمدة 24 ساعة, وقبل اجراء العمليه بخمسه عشر دقيقه تم حقنهم بمحلول ملحي بتركيز 0.9٪ داخل البرتونيوم. المجموعة الثالثه: تم حقنهم بماده L-NAMEداخل البرتونيوم خمسه عشر دقيقه قبل ان يخضعوا لنقص تروية دماغي عابر لمدة 30 دقيقة واعاده لضخ الدم لمدة 24 ساعة. وقد أجريت التجارب على السلوك العصبي قبل وفي أوقات مختلفة خلال الدراسة التجريبية في كل المجموعات. وفي نهاية الفترة التجريبية قتلت كل الفئران وقد أزيل المخ بسرعة وتم التقييم الكمي للموادالتاليه: Nuclear factor kappaβ (NF-қβ) باستخدام طريقه western blotting وقياس Tumor necrosis factor-α (TNF-α) بواسطه الانزيم اميونو ايسي وتم قياس اكسيد النتريك (النتريت والنترات)، و إجمالي القدرة المضادة للأكسدة Total antioxidant capacity(TAC) وقياس Malondialdehyde(MDA) عن طريق القياس اللوني في كل من من البلازما ونصف الكرة المخية المتأثرة. النتائج: تم التعبير عن النتائج بواسطه (الوسيط ± الانحراف المعياري), بعد حقن L-NAME لوحظ تحسن كبير في العجز العصبي والاعاقه الجسديه (15.07±0.584) بالمقارنة مع المجموعتين الاولي والثانيه (0 12.798±0.689, 17.50±0.707على التوالي P <0.001). فيما يتعلق بمستوى NF-қβ الذي قيس في نصف الكرة المخية المتأثرة, فقد لوحظ زياده ذات دلاله احصائيه وثيقه في المجموعه الثانيه (129.2±1.7 RGB unit/mg protein) مقارنة مع المجموعة المراقبة (53±1.03RGB unit/mg protein) وعلاوة على ذلك, فان المعالجه بواسطه L-NAME قبل نقص الترويةItem Spoligotyping patterns and drug resistant of Mycobacterium tuberculosis in Sudan(Al-Neelain University, 2009) Ghada Suliman Sharaf-EldinABSTRACT . Sudan has a high burden of tuberculosis with an estimated 93,000 new cases each year. The purpose of this study was to investigate the genotypic patterns of M. tuberculosis strains circulating in Sudan and to assess their susceptibly to anti-tuberculosis drugs. Isolates from 237 smear positive tuberculosis patients were collected from different geographic regions of the country. Spoligotyping was performed by the Kamerbeek method and results were compared with the international SpolDB4 database (Institut Pasteur, Guadeloupe). Results revealed 28 clusters ranging in size from 12 to 57 isolates. Seventy unique (unclustered) strains were observed, representing 30% of the strains examined. The most frequently observed spoligotype patterns belonged to the CAS family which represented 115 (48.5%) of isolates studied. T1, H3, U and Beijing strains were found in 12 (5.1%), 11 (4.6%), 7 (3%) and 6 (2.5%) patients respectively. Strains belonging to the Beijing family were found mainly in Western Sudan. Resistance to isoniazid, rifampicin, ethambutol and streptomycin was observed in 18.1, 22.4, 22.2 and 32% of strains respectively. Twenty patients (8.4%) had MDR-TB of which 10 were new cases. Seventeen patients with rifampicin resistant tuberculosis were infected with CAS1-DELHI strains matching SIT 25 of the SpolDB4 database and 3 were of the SIT 1 Beijing family. 15 loci MIRU-VNTR typing subdivided the 17 CAS strains into one cluster of 5, two clusters of 2 and 8 individual MIRU types. Similarly the 3 Beijing spoligotypes were differentiated into a cluster of 2 and a single strain. x The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigation in Sudan. However, caution must be used when interpreting clustered spoligotype patterns in this region. xi مستخلص يقدر عدد الحال ت الجديدة من المصابين بمرض السل الرئوي كل عام بحوالي 93 ألف حالة. تهدف هذه الدراسة إلى إجراء اختبارا ت تنمط نوعي على عينا ت من سلل ت الجراثيم الدقيقة المنتشرة في السودان ، إضافة إلى عمل تقييم قابلية استجابتها لعقاقير المضادة لحال ت السل الرئوي . تم عزل اللطاخا ت الموجبة لعدد 237 مريض من مرضى السل الرئوي الذين تم جمع عيناتهم من مناطق جغرافية مختلفة من القطر . حيث تم إجراء عمليا ت التنميط النوعي بواسطة طريقة كامربيك وتم إجراء مقارنة مع قواعد بيانا ت ذا ت معايير دولية تمثلت في معهد باستير قوادالوبي . أظهر ت النتائج أن إجمالي المجموعا ت المفحوصة بلغ 28 مجموعة تفاوتت أحجام العزل لها بين 12 إلى 57 . ولوحظ أن هناك 70 نوعاً من النواع الفريدة من تلك السلل ت غير المنضوية تحت عوائل مجموعة محددة وأن ما نسبته 30 %من تلك السلل ت قد أجريت عليه الختبارا ت . وقد لوحظ أن أكثر النماذج التي أجريت عليها اختبارا ت التنميط النوعي تعود لعوائل موطنها الصلي أواسط قارة آسيا ، وقد أجريت عليها دراسا ت عزل قد بلغت في مجملها 115 دراسة ـ أي ما نسبته 48 ، %فيما وجد أن عدد ونسبة المر ضى المصابين بالسل الرئوي من سلل ت توسكاني 1 ، هارليم 3 ،يورال وبيجينغ قد بلغت 12 ) بنسبة 1.5 ، (%11 ) بنسبة 6.4 ، (%7) بنسبة 3 (%و 6) بنسبة 5.2 (%على التوالي. وتتواجد السلل ت التي تنتمي إلى عائلة بيجينغ بصفة رئيسية في غرب السودان. حيث لوحظ أن نسبة تواجد مقاومة العزل ، للريفامبيسين ، إثامبيوتول والستريبتومايسين في بعض العوائل بلغت 1.18، 4.22 ، 2.22 وبنسبة إجمالية 32 %على التوالي . عشرون من مرضى السل الرئوي وجد أن لديهم خاصية مقاومة عقاقير متعددة للمرض وبما نسبته (4.8 (%سجلت عشرة حال ت منهم كحال ت جديدة. أثبت المسح أن سبعة عشر مريضاً ممن يتناولون مضاد الريفامبيسين للسل الرئوي مصابون بالمرض الذي ينحدر من عوائل يعود موطنها الصلي لواسط قارة آسيا – دلهي حيث يتطابق ذلك مع 25 منهم 4 شملهم الفحص بواسطة قواعد البيانا ت SpolDB و 3 من النواع الشائعة ST من عائلة بيجينغ حيث جاء التقسيم الفرعي لـ 17 سللة تحت سللة رئيسية واحدة من أصل 5 ، سللتان من أصل إثنين و 8 من السلل ت الفردية أصبح تحت فرع العوائل المستجيبة لنواع الـميرو MIRU . وعلى ذا ت المنوال انفصل التنميط النوعي لسللة بيجينغ إلى سللتين وسللة فردية واحدة .إن استخدام التنميط الجزئي للسللة يوفر طرق فعالة من تلك الطرق التي يستهل بها تصنيف العوائل السللية وليس الدمج فحسب، بل حتى في طرق الرقابة التقليدية للمسوحا ت المنتشرة في السودان . وفي ذا ت الصدد ؛ يجب أخذ الحيطة عند عمل التحاليل التفسيرية لنماذج التنميط لعوائل المجموعا ت في هذه المنطقة.Item Spoligotyping patterns and drug resistant of Mycobacterium tuberculosis in Sudan(Al Neelain University, 2009) Ghada Suliman Sharaf-Eldin. Sudan has a high burden of tuberculosis with an estimated 93,000 new cases each year. The purpose of this study was to investigate the genotypic patterns of M. tuberculosis strains circulating in Sudan and to assess their susceptibly to anti-tuberculosis drugs. Isolates from 237 smear positive tuberculosis patients were collected from different geographic regions of the country. Spoligotyping was performed by the Kamerbeek method and results were compared with the international SpolDB4 database (Institut Pasteur, Guadeloupe). Results revealed 28 clusters ranging in size from 12 to 57 isolates. Seventy unique (unclustered) strains were observed, representing 30% of the strains examined. The most frequently observed spoligotype patterns belonged to the CAS family which represented 115 (48.5%) of isolates studied. T1, H3, U and Beijing strains were found in 12 (5.1%), 11 (4.6%), 7 (3%) and 6 (2.5%) patients respectively. Strains belonging to the Beijing family were found mainly in Western Sudan. Resistance to isoniazid, rifampicin, ethambutol and streptomycin was observed in 18.1, 22.4, 22.2 and 32% of strains respectively. Twenty patients (8.4%) had MDR-TB of which 10 were new cases. Seventeen patients with rifampicin resistant tuberculosis were infected with CAS1-DELHI strains matching SIT 25 of the SpolDB4 database and 3 were of the SIT 1 Beijing family. 15 loci MIRU-VNTR typing subdivided the 17 CAS strains into one cluster of 5, two clusters of 2 and 8 individual MIRU types. Similarly the 3 Beijing spoligotypes were differentiated into a cluster of 2 and a single strain. x The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigation in Sudan. However, caution must be used when interpreting clustered spoligotype patterns in this region